Journal of Community Health Nursing
ISSN: 0737-0016 (Print) 1532-7655 (Online) Journal homepage: http://www.tandfonline.com/loi/hchn20
Stress Related to Family Change Among Vietnamese Refugees Patricia G. Fox To cite this article: Patricia G. Fox (1991) Stress Related to Family Change Among Vietnamese Refugees, Journal of Community Health Nursing, 8:1, 45-56, DOI: 10.1207/ s15327655jchn0801_5 To link to this article: http://dx.doi.org/10.1207/s15327655jchn0801_5
Published online: 07 Jun 2010.
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JOURNAL OF COMMUNITY HEALTH NURSING, 1991,8(1), 45-56 Copyright @ 1991, Lawrence Erlbaum Associates, Inc.
Stress Related to Family Change Among Vietnamese Refugees Patricia G. Fox, PhD, RN Downloaded by [University of Cambridge] at 02:57 06 November 2015
University of Illinois at Chicago
Because life changes have been known to have consequences for emotional and physical well-being, this study demonstrates the need for community health nurses (CHNs) to assess structural and functional changes in Vietnamese refugee spousal relations as possible sources of stress following resettlement. The purpose of this study was to identify changes in the structural and functional dimensions of family life and assess their impact on spousal relations. The major variables considered in effecting change in spousal interactions were relocation, exposure to more liberal attitudes toward gender equality in the United States, and wife employment. Spousal power differentials and affectivity were used as measures of change. Intensive interviews, using a semistructured interview guide, were conducted with 30 Vietnamese refugee women; the sample was nonrandom and cross-sectional. Information was collected on sociodemographic characteristics and pre- and postresettlement spousal relations. Wife employment, associated with proficiency in English and longer length of residence in the U.S., was found to promote more egalitarian spousal relations and greater spousal affectivity. When wives were not employed, they tended to describe an increase in affectivity without an appreciable decrease in spousal power differentials. This effect was enhanced by isolation within the host society as a result of limited English skills, unemployment, and a shorter length of residence.
BACKGROUND We still have no systematic study on the Vietnamese families in America, but the literature provides us with descriptions of traditional Vietnamese families in general. We know that by cultural tradition, Vietnamese women are dominated by male authority, and there is a conspicuous pattern of gender role segregation (Hammer, 1966), with emphasis on kinship cohesion (Zaharlick & Brainard, 1987). Although the traditional norms of Vietnamese spousal relations are easy to document, few empirical studies of the Vietnamese family in transition are available. Three factors that suggest the possibility of structural and functional changes in Requests for reprints should be sent to Patricia G. Fox, PhD, RN, Clinical Instructor, College of Nursing, Department of Public Health Nursing, University of Illinois at Chicago, 845 South Damen Avenue, Chicago, IL 60612.
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Vietnamese refugee families in Chicago are: (a) socioeconomic downward mobility, (b) the segmentation of families resulting in their isolation from kin, and (c) the increased employment of wives (Caplan, Whitmore, & Choy, 1989). For those women who immigrated with their husbands, our major research question was whether structural and functional changes associated with resettlement were also associated with changes in conjugal power relations and "affective bond." While recognizing that power is a multidimensional variable, this study defines it as the ability to influence family decisions, including which household labor one will perform. Spousal affectivity is defined as the level of intensity of interaction and the degree of emotional interdependency. The theoretical and empirical literature describes the following relationships between the structural and functional components of family life in open and closed family systems: (a) The open family system tends to provide support for the segregation of roles both within and outside the home, with a combined high degree of spousal power differentials in favor of the husbands, and low affectivity; and (b) the closed family system tends to provide support for joint activities, including decision making and household labor, with a combined low degree of spousal power differentials and high affectivity. The closed family system is most often associated with Western society (Liu, 1977). In addition, the recent increase in employment of wives in Western society could create a functional need for the increased participation of husbands in household tasks, and a decrease in the power differentials between husbands and wives. According to Liu's (1977) theory, joint activities, including shared household labor and decreasing conjugal power differentials, should be accompanied by an increase in affective bond between these couples. We would also suggest that these life changes hold explicit ramifications for the amount of stress experienced by Vietnamese refugee families (Lin-Fu, 1988). CHNs will want to recognize these areas of stress as they assess the health status of families and their individual members in order to plan appropriate interventions for stress reduction.
METHOD The instrument for this study was the semistructured, open-ended interview guide. This method was selected as the most appropriate means to obtain rich, detailed data concerning spousal and family relations in Vietnamese refugee families. Additionally, the use of open-ended questions and probes provided a maximum opportunity for women to spontaneously discuss their definitions of the setting and their experience. One of the major problems in conducting cross-cultural research pertains to the conceptual equivalence of the variables being measured. This problem was addressed by enlisting the help of a research assistant who was Vietnamese. She participated in the creation of meaningful questions to help ensure that the interview would produce material that was relevant to the women's lives and their relation-
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ships with their husbands and families. This approach has been suggested and used by many researchers (Meyers, 1977; Warwick & Lininger, 1975). Back translation was developed as a method of confronting the problem of developing cross-cultural instruments for comparative research. Essentially, back translation is a procedure of successive translation to arrive at questions that have the same meaning in cross-cultural research. It seemed reasonable to adopt this method for this study to increase the appropriateness and validity of the instrument. In this case, the semistructured, open-ended interview schedule was successively translated from English to Vietnamese, until a shared meaning of terms had been achieved. To evaluate the interview guide, trial interviews were conducted with three of the women who were included in the sample. The guide proved to be satisfactory in that it fostered flexibility within the interview situation and elicited descriptive information from the women.
DATA COLLECTION
Intensive semistructured, open-ended interviews were conducted with 30 Vietnamese refugee women who were married to their present spouses in Vietnam. The purpose of the study and the voluntary nature of the participation was explained to all of the women, both at the time of request for the interview and before the start of each interview. Permission was requested from each woman to tape-record the interview. None objected to this procedure. By recording the interview, full attention could be devoted to the women's responses. Having each full interview on tape also greatly helped in the analysis of data and ensured the quality of the material. The research assistant successively translated from English to Vietnamese as needed throughout the course of the interviews. Socioeconomic data were collected about each woman and her spouse. When appropriate, questions were asked about social characteristics and demographics before and after relocation in the host society (see Table 1). Questions relating to spousal decision making and task performance, as well as the decision-making process, were collected as power indicators. Attention was also directed toward obtaining information about the degree to which the family was open or closed to the participation of family members outside the nuclear unit. Data was also collected on the affective dimensions of the spousal relationship. Included were questions concerning emotional involvement, amount and quality of time spent together, activities shared, and frequency and types of disagreements. In addition, questions addressed the couple's role patterns, whether joint or segregated. Earlier investigators of this population have noted the difficulties in gaining the confidence of respondents due to the contextual differences between the life experience of the Vietnamese and Americans (Liu & Cheung, 1985; Montero, 1977). Although Americans have become accustomed to social science surveys, especially since World War 11, most Vietnamese had never been interviewed until their arrival
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Fox TABLE 1 Demographic Characteristics of Study Participants: Duration of Marriage, and Years of Residence in the US., By Ages
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Age at Time of Interview
Duration of Marriage 4 to 8 years 14 to 18 years 19 to 23 years 24 to 28 years 29 to 33 years 34 to 38 years Total Years in U.S. 1 to 3 4 to 6 7 to 9 10 to 12 Total
25 to 29
30 to 34
35 to 39
40to 44
45 to 49
4
2 3
4
2 6 2
1 1
50 to 54
57
Total
6 10 8 4 1
1
2 1 1
1
30
3 2
3
1
4
3
2 3
1
1 1
1 1 1
1 1
1
14 7 7
2 30
in resettlement camps. Moreover, 30 years of war in Vietnam has led to suspicion and fear of communist agents' surveillance. For this reason, the term investigator was avoided because it often precipitates images of the secret police who are generally known for the exploitation of the Vietnamese people (Yu, 1982). Entrance into the Vietnamese community was established through contact with a Vietnamese refugee woman who came to the U.S. as one of the "boat people" in 1980. She attended a university in Chicago and is presently employed as a social worker for a Vietnamese voluntary organization in Chicago. This research assistant was interested in the study because of her interest in helping refugee women. She generously volunteered to help find respondents, critique the instrument for conceptual equivalence, and attend interview sessions to translate between English and Vietnamese when needed. The Vietnamese refugee women's acceptance of both myself and this study was facilitated by the high level of trust and respect they held for the research assistant. On April 29, 1975, Saigon was overtaken with communist military force. The U.S. Embassy closed. The decision of the U.S. government to abandon the war effort left hundreds of thousands of Indochinese vulnerable to communist reprisals, including death (Montero, 1979). The majority of the refugees fled Vietnam via the South China Sea. It is estimated that half died en route, falling victim to drowning, starvation, illness, piracy, and hostile troops. Congress passed the Indochina Migration and Refugee Assistance Act in May, 1975, Public Law (PL) 94-23. This legislation allowed President Ford to admit some 130,000 Vietnamese and Cambodian refugees into the U.S. in 1975 (Liu, Larnanna, & Murata, 1979). Second wave migration began in 1977 in response to intensified political repression in Vietnam, Karnpuchia (Cambodia), and Laos. Most refugees have arrived
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since 1978, the peak year being 1980. Between 1970 and 1986, 90,000 Vietnamese were naturalized in the U.S.Presently 50% have been in the U.S.less than 7 years (Vietnamese Association of Illinois [VAI], 1989). Few families reached the U.S.with all of their immediate members. To date, about 35% continue to live below the poverty line (VAI, 1989). Of the estimated 17,000 Vietnamese refugees resettled in Illinois, approximately 12,000 live in the metropolitan Chicago area (VAI, 1989).
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Sample All of the women were married to their present husbands in Vietnam. At the time of the study they had been married from 6 to 38 years, with a median length of marriage of 16.6 years. l b o of the women had been married previously: one for l year and 1 for 2 years. They ranged in age from 25 to 57 years, with a median age of 38.4 years. Twenty-one of the women were at least 3 years younger than their husbands, while 7 were 5 or more years younger than their husbands. Only 2 women were older than their husbands by 1 year. The number of children born to these women in Vietnam ranged from one to six, with a median of 2.9 children per woman. One woman had two children who were born in a refugee camp in Thailand, and another had a child born in a refugee camp in %wan. Although there were various reasons for each woman and her family to escape from Vietnam, the underlying motivation in every situation was communist oppression with its concomitant lack of personal and political freedom.
DATA ANALYSIS The general goal of data analysis in qualitative research methodology is the distillation of classes, concepts, and categories and organization of them in a way that accounts for the majority of the data. Identification of recurring themes in the data continued throughout the 6 months of data collection. Coding categories for the data were continuously developed, tried, refined, and rejected. Initially, categories evolved from consideration of interview data; the category system was shaped and refined with the processing of additional interview data. Finally, all data from the 30 interviews were coded with one numerically and alphabetically identified category system. Conjugal power and affectivity were examined as indicators of family change. Information collected and coded from interviews included: sociodemographic characteristics, type of family system (open or closed), type of role pattern (joint or segregated), decision making (syncretic or autonomic), and wife employment (see Table 2). Relevant quotations were utilized to illustrate pertinent findings. The women's experiences unfolded within the context of the interview. The interviewer and research assistant were the vehicles through which data were shaped and revealed. The data are valid to the extent they represent the conjugal lives presented by the women.
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Fox TABLE 2 Variables With Definitions Definitions ---
Independent Variables Sociodemographic characteristics Family system
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Role pattern
Decision making
Wife employment Dependent Variables Spousal power Spousal affectivity
Age, education, occupation, religion, rural/urban, number of years married, and numbers of years in U.S. Duty and obligation to seek advice from family members outside the nuclear unit. Closed: Decision making confined to the spousal couple. Segregated: Independent activities both within and outside the home. Joint: Shared activities both within and outside the home. Autonomic: Husband and wife make decisions independent of each other. Syncretic: Husband and wife make decisions together. Working for a wage outside of the family unit.
+:
The ability to influence family decisions, including which household labor one will perform. Level of intensity of interaction and the degree of emotional interdependency.
FINDINGS Spousal Power and Affectivity: The Effects of Family System and Wife Employment One of the more pervasive structural changes for Vietnamese refugees was the shift from an open to a closed family system. The change to a closed family system, for most of the women, also resulted in nuclearization of the family. These structural rearrangements, in turn, induced functional changes in family relations. For example, decision making was now confined to the spousal couple, because they no longer had the duty to seek advice and consent from parental families. Although this area of family interaction had changed, it was not accompanied by an appreciable decrease in spousal power differentials. This finding held for the majority of spousal couples, regardless of family system and residential pattern, when the wife was not employed (see Figure 1). The majority of these couples with non-earning wives demonstrated more autonomous patterns of decision-making pre- and postresettlement. In addition, women tended to continue to hold the attitude that their husbands had the legitimate right to make final decisions. They would also, for the most part, withdraw from spousal conflict to maintain harmony within the family. Although most of these women had independent incomes in Vietnam, we speculated that the loss of this resource did not have an effect on spousal power differentials for two reasons: (a) In Vietnam, the political, economic, and kinship systems structurally and ideologically supported male dominance; and (b) the wife's income was not necessary to ensure the family's survival. A second salient finding was that affectivity increased for these spousal couples
Stress Related to Family Change
T
Pre-Resettlement
51
Spousal Power Differential
Segregated Conjugal
Spousal
Family
Affectivity
For Male Dominance Post-Resettlement
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Joint Conjugal Roles
-
Exposure to Egalitarian Norms System
Spousal Power Differential
T
Spousal Affectivity
Wife Employment Spousal Power Social Isolation
Differential
Husband Not Employed Spousal System Affectivity
7
Wife Not Employed
FIGURE 1 Schematic presentation of social systems and vietnamese conjugal relations, pre- and post resettlement.
independent of a change in power differentials. This finding also held independent of family system and residential pattern when the wife was not employed. From the women's perspectives, the disruption of family ties tended to increase spousal interdependency and emotional involvement. These factors were further enhanced by social isolation, which resulted from unemployment for both spouses, and limited English language skills. These couples tended to have more joint relations, as demonstrated by the husband's increased participation in household tasks and child care. This change in behavior for husbands was usually precipitated by their being unemployed and spending most of their days at home. When the wife was not employed, regardless of family type, couples were less likely to experience a decrease in power differentials with a concomitant increase in affectivity. In the few situations where a decrease in spousal power differentials occurred, the women attributed the change to the fact that they no longer resided with their husbands' parental families. The loss of parental support for the husband resulted in women feeling a greater sense of independence in expressing their views, even when they conflicted with their husbands' views. An increase in spousal affectivity was again associated with greater mutual interdependency and higher emotional involvement, which resulted from isolation from family and limited interaction with the host society. In comparison, independent of family system, we noted a decrease in spousal
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power differentials with a concomitant increase in affectivity for couples when the wife was employed. The effect of wife employment was associated with length of residence, English language skills, and exposure to more liberal attitudes toward gender relations in the U.S. Earning wives also tended to have fewer children born after resettlement than did non-earning wives. The women attributed their increased participation in decision making to their having incomes of their own. They also noted the disparities between spousal decision making in Vietnam and the U.S. Many women stated that they preferred the more egalitarian arrangement. A few felt less secure in their new cultural setting. The apparent ease with which spousal couples divorce in the U.S. left women feeling concerned about the stability of their own conjugal relations. Earning wives also differed from non-earning wives by their heightened sense of well-being. Employment not only allowed women to ensure their families' economic survival, but increased their feelings of self-worth, and gave them the opportunity to interact with the outside world. Being able to relate in the host society contributed to the development of necessary functional skills and exposed them to a new set of cultural norms. On the other hand, non-earning wives were isolated within their homes, usually with infants and young children. Social isolation, coupled with the loss of family and friends in Vietnam, left these women feeling lonely and sometimes afraid. There were real concerns about surviving on public assistance, learning a new language, and finding employment for themselves or for their husbands. These women lived in large apartment complexes with no place for children to play outside. Many women had been no further than the immediate boundaries of their neighborhoods. All of these factors combined to leave these non-earning spousal couples in a more precarious state than their earning counterparts. Earning wives, like non-earning wives, tended to have more joint relations after resettlement. This was again evidenced by the husbands' greater participation in household tasks and child care. In this case, the increased participation of husbands was related to functional need, brought about by the wives' employment. According to earning views, the loss of family members tended to increase spousal interdependency and heighten emotional involvement. This finding held across family systems when both spouses worked the same hours. When women experienced a decrease in the quantity and quality of time they spent with their husbands, they were more apt to describe feelings of dissatisfaction with their conjugal relations. This occurred when spousal couples worked different hours. Conflict was apt to erupt in spousal power relations when wives pursued employment and furthered their education against their husbands' wishes. Although women had independent incomes in Vietnam, they generally were self-employed in small shops or as vendors. Normative restrictions in Vietnam tended to regulate against women working for someone outside the family unit. Following resettlement, some husbands maintained this attitude, and only conceded to their wives' employment because of economic need. Other husbands, who tended to be better educated, recognized their wives' need for activity outside of the home and more willingly agreed to their employment.
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In summary, for these earning and non-earning wives, the type of family system did not tend to be related to changes in spousal power differentials following resettlement. Conversely, when wives were employed, there was more of a tendency for spousal power differentials to decrease. This occurred when wife employment was associated with competency in English and a longer length of residence in the U.S., usually 3 or more years. These factors tended to increase women's exposure to more liberal attitudes concerning gender relations. The absence of family members, for both groups, produced greater interspousal dependency and higher emotional involvement. We speculated that the effect of this factor was increased for non-earning wives because they spent more time with their husbands.
DISCUSSION AND IMPLICATIONS A major finding of the study indicated that an increase in affectivity occurred without an appreciable decrease in spousal power differentials. Therefore, the increase in affectivity needed to be explained by something other than the husbands' loss of authority in the home. The women themselves explained the change in affectivity by describing increased mutual dependency and greater emotional involvement with their husbands after resettlement. They attributed the change to their being separated from family members and friends who remained in Vietnam or other areas of the U.S. Although this finding held independent of family system or wife employment, more women experienced an increase in affectivity without a decrease in spousal power differentials when both they and their husbands were not employed. Unemployment for both spouses was also associated with a lack of proficiency in English and a residency of 3 years or less in the U.S. These findings support those of Haines, Rutherford, and Thomas (1981) and Masuda, Lin, and Tazuma (1981), who have shown a covariance between English language skills, length of residence, and employment for refugees. Further studies using measures of affectivity will need to be conducted with larger samples of Vietnamese and other refugee groups to extend cross-cultural comparisons on this variable. To date, little attention has been directed toward defining and delineating the affective dimensions of spousal relations in recent immigrant and refugee groups. The affective elements of spousal interaction deserve greater exploration because of their implicit and explicit ramifications for general adaptation in a new society and its potential effect on refugee health status. As this study indicated, women who had greater affectivity displayed in their conjugal relations also experienced a heightened sense of well-being, which enabled them to cope more effectively in their daily lives. Conversely, when women perceived a decrease in spousal affectivity, they often felt lonely and isolated. This, in turn, decreased women's capacity for dealing with daily events. A second factor considered in this study was the effect of wife employment on
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conjugal relations. Specifically, family decision making and the participation of husbands in household tasks were used as measures of change in spousal power differentials. The findings of this study closely followed the work of Rodman (1967) and Safilious-Rothschild (1979), who argued that the cultural context in which resources operate is important in determining their effects. This study indicated that the wife's belief system and her employment were important factors stimulating egalitarian spousal behavior. Although wife employment may have functioned as a catalyst accelerating the implementation of the egalitarian ethic, employment in itself did not guarantee more egalitarian interchange. The greatest change in spousal power differentials was apt to occur when the wife was employed and had exposure to egalitarian norms. Exposure to more liberal attitudes toward gender relations was in turn associated with competency in English and longer residency in the U.S. This study also explored the women's attitudes toward their employment. Although most women did not find intrinsic job satisfaction under their present working conditions, they did describe other rewards associated with their employment. These included self-esteem, the opportunity to interact with the outside world, and a sense of satisfaction in being able to contribute to their families' economic survival. The reasons for the disparities in women's feelings concerning their employment, under conditions of low job satisfaction, need further empirical investigation. The study additionally tended to support the use of a dynamic conceptual model that deals with the reciprocal nature of family discussions and negotiations that take place, rather than using a static model which focuses on the outcomes of family process. We focused on communication processes and attempted to delineate the strategies wives used in negotiating and resolving conflict with their husbands. This approach was less concerned with who won (i.e., outcome), than with the process by which the husband and wife resolved their differences. Although type of family system did not seem to have an appreciable effect on spousal power differentials following resettlement, it was an important factor in evaluating spousal interaction and communication processes. The data supported Liu's (1977) argument by further indicating the importance of distinguishing between open and closed family systems in cross-cultural analysis. Changes in the functional and structural dimensions of spousal relations hold implications for those persons' general health status as they begin to adapt to an alien environment. For example, women who experience a decrease in spousal affectivity also acknowledged stress in other areas of their lives. For this group of women, the loss of support systems with its concomitant feeling of loneliness, lead to a decreased ability to cope in a strange and often confusing social and cultural milieu. All forms of losses which result in stress, lead to a decreased ability of the bodys' immune system to resist illness. CHNs will therefore want to consider disruption in refugee conjugal relations as a possible source of stress. For example, questions that are useful in assessing this area include: Do you and your husband spend more or
Stress Related to Family Change
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less time together? Do you argue more or less frequently? How does your husband feel about you working outside of the home? How do you feel about working outside of the home? Although this study addresses change in Vietnamese refugee spousal relations, we would suggest that the basic concepts of assessing functional and structural changes in conjugal relations could be extrapolated to other refugee and immigrant groups.
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CONCLUSION
"Becoming" a refugee, with its psychosocial, political, and economic ramifications, is a catastrophic life change. It is an upheaval of all that is known and familiar. It is a series of losses, which include country, home, family members, and friends. Previous support systems may be lost and earlier coping patterns may no longer be useful. Extensive research has demonstrated that the incidence of illness increases as more life change is experienced (T. S. Holmes & T. H. Holmes, 1975; Wyler, Masuda, & T. H. Holmes, 1971). In addition, when psychosocial emotional status deteriorates, there may be an increase in the severity of illness and a prolonged period of recovery (Rahe, 1978). In general, there has been very limited work done in which the health status of refugees has been viewed in relation to social risk factors. A change in spousal relations, whether viewed as positive or negative, will have an impact on the well-being of every family member. This study revealed that community health nursing assessment of the family will be strengthened by considering the health implications of stress, as related to structural and functional changes in conjugal relations. Furthermore, nursing assessments will help to develop an empirical base for interventions which will potentially maximize refugee family adaptation in the U.S. REFERENCES Caplan, N., Whitmore, J., & Choy, M. (1989). The boat people and achievement in America: A study of family values, hard work, and cultural values. Ann Arbor: The University of Michigan Press. Haines, D., Rutherford, D., & Thomas, P. (1981). Family and community among Vietnamese refugees. International Migration Review, 15, 310-3 19. Hammer, E. (1966). Vietnam yesterday and today. New York: Holt, Rinehart & Winston. Holmes, T. S., & Holmes, T. H. (1975, May). Risk of illness. Continuing Education, 48-51. Lin-Fu, J . (1988). Population characteristics and health care needs of Southeast Asian Americans. Public Health Reports, 103(1), 18-27. Liu, W. T. (1977). The myth of nuclearization of the family in the Philippines. In L. Lenero (Ed.), Beyond the Nuclear Family Model (pp. 36-61). Beverly Hills, CA: Sage. Liu, W. T., & Cheung, E (1985). Research concerns associated with the study of Southeast Asian refugees. In T. Owan (Ed.), Southeast Asian mental health (pp. 487-509). Washington, DC: National Institute of Mental Health. Liu, W. T., Lamanna, M., & Maurata, A. (1979). nansition to nowhere: Vietnamese refugees in America. Nashville, TN: Charter House. Masuda, M., Lin, K. M., & Tazuma, L. (1981). Adaptation problems of Vietnamese refugees. Archives of General Psychiatry, 37, 447-450.
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Meyers, U. (1977). Survey methods for minority communities. Journal of Social Issues, 33, 11-19. Montero, D. (1977). Research among racial and cultural minorities: An overview. Journal of Social Is-
sues, 33(4), 1-10. Montero, D. (1979). VietnameseAmericans: Patterns of resettlement and socioeconomic adaptation in the United States. Boulder, CO: Westview. Public Law 94-23, Indochina Migration and Refugee Assistance Act, May 1975. Rahe, R. H. (1978). Life change measurement as a predictor of illness. Social Medicine, 61, 1124. Rodman, H. (1967). Marital power in France, Greece and the United States. Journal of Marriage and the Family, 29, 320-324. Safilious-Rothschild, C. (1970). The study of family power structure: A review 1960-1969. Journal of
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Marriage and the Family, 32, 539-552. Warwick, D. P., & Lininger, C. A. (1975). The Sample Survey: Theory and practice. New York: McGraw-Hill. Wyler, A. R., Masuda, M., & Holmes, T. H. (1971). Magnitude of life events and serious illness. Psy-
chosomatic Medicine, 33, 115. Yu, E. (1982). Problems in Pacific/Asian American community research. In W. T. Liu (Ed.), Methodological problems in minority research (pp. 93-114). Chicago: Pacific Asian American Mental Health Research Center. Vietnamese Association of Illinois. (1989). Annual report. Chicago: Author. Zaharlick, A., & Brainard, J. (1987). Demographic characteristics, ethnicity and the resettlement of southeast Asian refugees in the United States. Urban Anthropology, 16(3-4), 327-372.
ISSN: 0737-0016 (Print) 1532-7655 (Online) Journal homepage: http://www.tandfonline.com/loi/hchn20
Stress Related to Family Change Among Vietnamese Refugees Patricia G. Fox To cite this article: Patricia G. Fox (1991) Stress Related to Family Change Among Vietnamese Refugees, Journal of Community Health Nursing, 8:1, 45-56, DOI: 10.1207/ s15327655jchn0801_5 To link to this article: http://dx.doi.org/10.1207/s15327655jchn0801_5
Published online: 07 Jun 2010.
Submit your article to this journal
Article views: 6
View related articles
Citing articles: 8 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=hchn20 Download by: [University of Cambridge]
Date: 06 November 2015, At: 02:57
JOURNAL OF COMMUNITY HEALTH NURSING, 1991,8(1), 45-56 Copyright @ 1991, Lawrence Erlbaum Associates, Inc.
Stress Related to Family Change Among Vietnamese Refugees Patricia G. Fox, PhD, RN Downloaded by [University of Cambridge] at 02:57 06 November 2015
University of Illinois at Chicago
Because life changes have been known to have consequences for emotional and physical well-being, this study demonstrates the need for community health nurses (CHNs) to assess structural and functional changes in Vietnamese refugee spousal relations as possible sources of stress following resettlement. The purpose of this study was to identify changes in the structural and functional dimensions of family life and assess their impact on spousal relations. The major variables considered in effecting change in spousal interactions were relocation, exposure to more liberal attitudes toward gender equality in the United States, and wife employment. Spousal power differentials and affectivity were used as measures of change. Intensive interviews, using a semistructured interview guide, were conducted with 30 Vietnamese refugee women; the sample was nonrandom and cross-sectional. Information was collected on sociodemographic characteristics and pre- and postresettlement spousal relations. Wife employment, associated with proficiency in English and longer length of residence in the U.S., was found to promote more egalitarian spousal relations and greater spousal affectivity. When wives were not employed, they tended to describe an increase in affectivity without an appreciable decrease in spousal power differentials. This effect was enhanced by isolation within the host society as a result of limited English skills, unemployment, and a shorter length of residence.
BACKGROUND We still have no systematic study on the Vietnamese families in America, but the literature provides us with descriptions of traditional Vietnamese families in general. We know that by cultural tradition, Vietnamese women are dominated by male authority, and there is a conspicuous pattern of gender role segregation (Hammer, 1966), with emphasis on kinship cohesion (Zaharlick & Brainard, 1987). Although the traditional norms of Vietnamese spousal relations are easy to document, few empirical studies of the Vietnamese family in transition are available. Three factors that suggest the possibility of structural and functional changes in Requests for reprints should be sent to Patricia G. Fox, PhD, RN, Clinical Instructor, College of Nursing, Department of Public Health Nursing, University of Illinois at Chicago, 845 South Damen Avenue, Chicago, IL 60612.
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Vietnamese refugee families in Chicago are: (a) socioeconomic downward mobility, (b) the segmentation of families resulting in their isolation from kin, and (c) the increased employment of wives (Caplan, Whitmore, & Choy, 1989). For those women who immigrated with their husbands, our major research question was whether structural and functional changes associated with resettlement were also associated with changes in conjugal power relations and "affective bond." While recognizing that power is a multidimensional variable, this study defines it as the ability to influence family decisions, including which household labor one will perform. Spousal affectivity is defined as the level of intensity of interaction and the degree of emotional interdependency. The theoretical and empirical literature describes the following relationships between the structural and functional components of family life in open and closed family systems: (a) The open family system tends to provide support for the segregation of roles both within and outside the home, with a combined high degree of spousal power differentials in favor of the husbands, and low affectivity; and (b) the closed family system tends to provide support for joint activities, including decision making and household labor, with a combined low degree of spousal power differentials and high affectivity. The closed family system is most often associated with Western society (Liu, 1977). In addition, the recent increase in employment of wives in Western society could create a functional need for the increased participation of husbands in household tasks, and a decrease in the power differentials between husbands and wives. According to Liu's (1977) theory, joint activities, including shared household labor and decreasing conjugal power differentials, should be accompanied by an increase in affective bond between these couples. We would also suggest that these life changes hold explicit ramifications for the amount of stress experienced by Vietnamese refugee families (Lin-Fu, 1988). CHNs will want to recognize these areas of stress as they assess the health status of families and their individual members in order to plan appropriate interventions for stress reduction.
METHOD The instrument for this study was the semistructured, open-ended interview guide. This method was selected as the most appropriate means to obtain rich, detailed data concerning spousal and family relations in Vietnamese refugee families. Additionally, the use of open-ended questions and probes provided a maximum opportunity for women to spontaneously discuss their definitions of the setting and their experience. One of the major problems in conducting cross-cultural research pertains to the conceptual equivalence of the variables being measured. This problem was addressed by enlisting the help of a research assistant who was Vietnamese. She participated in the creation of meaningful questions to help ensure that the interview would produce material that was relevant to the women's lives and their relation-
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ships with their husbands and families. This approach has been suggested and used by many researchers (Meyers, 1977; Warwick & Lininger, 1975). Back translation was developed as a method of confronting the problem of developing cross-cultural instruments for comparative research. Essentially, back translation is a procedure of successive translation to arrive at questions that have the same meaning in cross-cultural research. It seemed reasonable to adopt this method for this study to increase the appropriateness and validity of the instrument. In this case, the semistructured, open-ended interview schedule was successively translated from English to Vietnamese, until a shared meaning of terms had been achieved. To evaluate the interview guide, trial interviews were conducted with three of the women who were included in the sample. The guide proved to be satisfactory in that it fostered flexibility within the interview situation and elicited descriptive information from the women.
DATA COLLECTION
Intensive semistructured, open-ended interviews were conducted with 30 Vietnamese refugee women who were married to their present spouses in Vietnam. The purpose of the study and the voluntary nature of the participation was explained to all of the women, both at the time of request for the interview and before the start of each interview. Permission was requested from each woman to tape-record the interview. None objected to this procedure. By recording the interview, full attention could be devoted to the women's responses. Having each full interview on tape also greatly helped in the analysis of data and ensured the quality of the material. The research assistant successively translated from English to Vietnamese as needed throughout the course of the interviews. Socioeconomic data were collected about each woman and her spouse. When appropriate, questions were asked about social characteristics and demographics before and after relocation in the host society (see Table 1). Questions relating to spousal decision making and task performance, as well as the decision-making process, were collected as power indicators. Attention was also directed toward obtaining information about the degree to which the family was open or closed to the participation of family members outside the nuclear unit. Data was also collected on the affective dimensions of the spousal relationship. Included were questions concerning emotional involvement, amount and quality of time spent together, activities shared, and frequency and types of disagreements. In addition, questions addressed the couple's role patterns, whether joint or segregated. Earlier investigators of this population have noted the difficulties in gaining the confidence of respondents due to the contextual differences between the life experience of the Vietnamese and Americans (Liu & Cheung, 1985; Montero, 1977). Although Americans have become accustomed to social science surveys, especially since World War 11, most Vietnamese had never been interviewed until their arrival
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Fox TABLE 1 Demographic Characteristics of Study Participants: Duration of Marriage, and Years of Residence in the US., By Ages
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Age at Time of Interview
Duration of Marriage 4 to 8 years 14 to 18 years 19 to 23 years 24 to 28 years 29 to 33 years 34 to 38 years Total Years in U.S. 1 to 3 4 to 6 7 to 9 10 to 12 Total
25 to 29
30 to 34
35 to 39
40to 44
45 to 49
4
2 3
4
2 6 2
1 1
50 to 54
57
Total
6 10 8 4 1
1
2 1 1
1
30
3 2
3
1
4
3
2 3
1
1 1
1 1 1
1 1
1
14 7 7
2 30
in resettlement camps. Moreover, 30 years of war in Vietnam has led to suspicion and fear of communist agents' surveillance. For this reason, the term investigator was avoided because it often precipitates images of the secret police who are generally known for the exploitation of the Vietnamese people (Yu, 1982). Entrance into the Vietnamese community was established through contact with a Vietnamese refugee woman who came to the U.S. as one of the "boat people" in 1980. She attended a university in Chicago and is presently employed as a social worker for a Vietnamese voluntary organization in Chicago. This research assistant was interested in the study because of her interest in helping refugee women. She generously volunteered to help find respondents, critique the instrument for conceptual equivalence, and attend interview sessions to translate between English and Vietnamese when needed. The Vietnamese refugee women's acceptance of both myself and this study was facilitated by the high level of trust and respect they held for the research assistant. On April 29, 1975, Saigon was overtaken with communist military force. The U.S. Embassy closed. The decision of the U.S. government to abandon the war effort left hundreds of thousands of Indochinese vulnerable to communist reprisals, including death (Montero, 1979). The majority of the refugees fled Vietnam via the South China Sea. It is estimated that half died en route, falling victim to drowning, starvation, illness, piracy, and hostile troops. Congress passed the Indochina Migration and Refugee Assistance Act in May, 1975, Public Law (PL) 94-23. This legislation allowed President Ford to admit some 130,000 Vietnamese and Cambodian refugees into the U.S. in 1975 (Liu, Larnanna, & Murata, 1979). Second wave migration began in 1977 in response to intensified political repression in Vietnam, Karnpuchia (Cambodia), and Laos. Most refugees have arrived
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since 1978, the peak year being 1980. Between 1970 and 1986, 90,000 Vietnamese were naturalized in the U.S.Presently 50% have been in the U.S.less than 7 years (Vietnamese Association of Illinois [VAI], 1989). Few families reached the U.S.with all of their immediate members. To date, about 35% continue to live below the poverty line (VAI, 1989). Of the estimated 17,000 Vietnamese refugees resettled in Illinois, approximately 12,000 live in the metropolitan Chicago area (VAI, 1989).
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Sample All of the women were married to their present husbands in Vietnam. At the time of the study they had been married from 6 to 38 years, with a median length of marriage of 16.6 years. l b o of the women had been married previously: one for l year and 1 for 2 years. They ranged in age from 25 to 57 years, with a median age of 38.4 years. Twenty-one of the women were at least 3 years younger than their husbands, while 7 were 5 or more years younger than their husbands. Only 2 women were older than their husbands by 1 year. The number of children born to these women in Vietnam ranged from one to six, with a median of 2.9 children per woman. One woman had two children who were born in a refugee camp in Thailand, and another had a child born in a refugee camp in %wan. Although there were various reasons for each woman and her family to escape from Vietnam, the underlying motivation in every situation was communist oppression with its concomitant lack of personal and political freedom.
DATA ANALYSIS The general goal of data analysis in qualitative research methodology is the distillation of classes, concepts, and categories and organization of them in a way that accounts for the majority of the data. Identification of recurring themes in the data continued throughout the 6 months of data collection. Coding categories for the data were continuously developed, tried, refined, and rejected. Initially, categories evolved from consideration of interview data; the category system was shaped and refined with the processing of additional interview data. Finally, all data from the 30 interviews were coded with one numerically and alphabetically identified category system. Conjugal power and affectivity were examined as indicators of family change. Information collected and coded from interviews included: sociodemographic characteristics, type of family system (open or closed), type of role pattern (joint or segregated), decision making (syncretic or autonomic), and wife employment (see Table 2). Relevant quotations were utilized to illustrate pertinent findings. The women's experiences unfolded within the context of the interview. The interviewer and research assistant were the vehicles through which data were shaped and revealed. The data are valid to the extent they represent the conjugal lives presented by the women.
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Fox TABLE 2 Variables With Definitions Definitions ---
Independent Variables Sociodemographic characteristics Family system
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Role pattern
Decision making
Wife employment Dependent Variables Spousal power Spousal affectivity
Age, education, occupation, religion, rural/urban, number of years married, and numbers of years in U.S. Duty and obligation to seek advice from family members outside the nuclear unit. Closed: Decision making confined to the spousal couple. Segregated: Independent activities both within and outside the home. Joint: Shared activities both within and outside the home. Autonomic: Husband and wife make decisions independent of each other. Syncretic: Husband and wife make decisions together. Working for a wage outside of the family unit.
+:
The ability to influence family decisions, including which household labor one will perform. Level of intensity of interaction and the degree of emotional interdependency.
FINDINGS Spousal Power and Affectivity: The Effects of Family System and Wife Employment One of the more pervasive structural changes for Vietnamese refugees was the shift from an open to a closed family system. The change to a closed family system, for most of the women, also resulted in nuclearization of the family. These structural rearrangements, in turn, induced functional changes in family relations. For example, decision making was now confined to the spousal couple, because they no longer had the duty to seek advice and consent from parental families. Although this area of family interaction had changed, it was not accompanied by an appreciable decrease in spousal power differentials. This finding held for the majority of spousal couples, regardless of family system and residential pattern, when the wife was not employed (see Figure 1). The majority of these couples with non-earning wives demonstrated more autonomous patterns of decision-making pre- and postresettlement. In addition, women tended to continue to hold the attitude that their husbands had the legitimate right to make final decisions. They would also, for the most part, withdraw from spousal conflict to maintain harmony within the family. Although most of these women had independent incomes in Vietnam, we speculated that the loss of this resource did not have an effect on spousal power differentials for two reasons: (a) In Vietnam, the political, economic, and kinship systems structurally and ideologically supported male dominance; and (b) the wife's income was not necessary to ensure the family's survival. A second salient finding was that affectivity increased for these spousal couples
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T
Pre-Resettlement
51
Spousal Power Differential
Segregated Conjugal
Spousal
Family
Affectivity
For Male Dominance Post-Resettlement
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Joint Conjugal Roles
-
Exposure to Egalitarian Norms System
Spousal Power Differential
T
Spousal Affectivity
Wife Employment Spousal Power Social Isolation
Differential
Husband Not Employed Spousal System Affectivity
7
Wife Not Employed
FIGURE 1 Schematic presentation of social systems and vietnamese conjugal relations, pre- and post resettlement.
independent of a change in power differentials. This finding also held independent of family system and residential pattern when the wife was not employed. From the women's perspectives, the disruption of family ties tended to increase spousal interdependency and emotional involvement. These factors were further enhanced by social isolation, which resulted from unemployment for both spouses, and limited English language skills. These couples tended to have more joint relations, as demonstrated by the husband's increased participation in household tasks and child care. This change in behavior for husbands was usually precipitated by their being unemployed and spending most of their days at home. When the wife was not employed, regardless of family type, couples were less likely to experience a decrease in power differentials with a concomitant increase in affectivity. In the few situations where a decrease in spousal power differentials occurred, the women attributed the change to the fact that they no longer resided with their husbands' parental families. The loss of parental support for the husband resulted in women feeling a greater sense of independence in expressing their views, even when they conflicted with their husbands' views. An increase in spousal affectivity was again associated with greater mutual interdependency and higher emotional involvement, which resulted from isolation from family and limited interaction with the host society. In comparison, independent of family system, we noted a decrease in spousal
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Fox
power differentials with a concomitant increase in affectivity for couples when the wife was employed. The effect of wife employment was associated with length of residence, English language skills, and exposure to more liberal attitudes toward gender relations in the U.S. Earning wives also tended to have fewer children born after resettlement than did non-earning wives. The women attributed their increased participation in decision making to their having incomes of their own. They also noted the disparities between spousal decision making in Vietnam and the U.S. Many women stated that they preferred the more egalitarian arrangement. A few felt less secure in their new cultural setting. The apparent ease with which spousal couples divorce in the U.S. left women feeling concerned about the stability of their own conjugal relations. Earning wives also differed from non-earning wives by their heightened sense of well-being. Employment not only allowed women to ensure their families' economic survival, but increased their feelings of self-worth, and gave them the opportunity to interact with the outside world. Being able to relate in the host society contributed to the development of necessary functional skills and exposed them to a new set of cultural norms. On the other hand, non-earning wives were isolated within their homes, usually with infants and young children. Social isolation, coupled with the loss of family and friends in Vietnam, left these women feeling lonely and sometimes afraid. There were real concerns about surviving on public assistance, learning a new language, and finding employment for themselves or for their husbands. These women lived in large apartment complexes with no place for children to play outside. Many women had been no further than the immediate boundaries of their neighborhoods. All of these factors combined to leave these non-earning spousal couples in a more precarious state than their earning counterparts. Earning wives, like non-earning wives, tended to have more joint relations after resettlement. This was again evidenced by the husbands' greater participation in household tasks and child care. In this case, the increased participation of husbands was related to functional need, brought about by the wives' employment. According to earning views, the loss of family members tended to increase spousal interdependency and heighten emotional involvement. This finding held across family systems when both spouses worked the same hours. When women experienced a decrease in the quantity and quality of time they spent with their husbands, they were more apt to describe feelings of dissatisfaction with their conjugal relations. This occurred when spousal couples worked different hours. Conflict was apt to erupt in spousal power relations when wives pursued employment and furthered their education against their husbands' wishes. Although women had independent incomes in Vietnam, they generally were self-employed in small shops or as vendors. Normative restrictions in Vietnam tended to regulate against women working for someone outside the family unit. Following resettlement, some husbands maintained this attitude, and only conceded to their wives' employment because of economic need. Other husbands, who tended to be better educated, recognized their wives' need for activity outside of the home and more willingly agreed to their employment.
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In summary, for these earning and non-earning wives, the type of family system did not tend to be related to changes in spousal power differentials following resettlement. Conversely, when wives were employed, there was more of a tendency for spousal power differentials to decrease. This occurred when wife employment was associated with competency in English and a longer length of residence in the U.S., usually 3 or more years. These factors tended to increase women's exposure to more liberal attitudes concerning gender relations. The absence of family members, for both groups, produced greater interspousal dependency and higher emotional involvement. We speculated that the effect of this factor was increased for non-earning wives because they spent more time with their husbands.
DISCUSSION AND IMPLICATIONS A major finding of the study indicated that an increase in affectivity occurred without an appreciable decrease in spousal power differentials. Therefore, the increase in affectivity needed to be explained by something other than the husbands' loss of authority in the home. The women themselves explained the change in affectivity by describing increased mutual dependency and greater emotional involvement with their husbands after resettlement. They attributed the change to their being separated from family members and friends who remained in Vietnam or other areas of the U.S. Although this finding held independent of family system or wife employment, more women experienced an increase in affectivity without a decrease in spousal power differentials when both they and their husbands were not employed. Unemployment for both spouses was also associated with a lack of proficiency in English and a residency of 3 years or less in the U.S. These findings support those of Haines, Rutherford, and Thomas (1981) and Masuda, Lin, and Tazuma (1981), who have shown a covariance between English language skills, length of residence, and employment for refugees. Further studies using measures of affectivity will need to be conducted with larger samples of Vietnamese and other refugee groups to extend cross-cultural comparisons on this variable. To date, little attention has been directed toward defining and delineating the affective dimensions of spousal relations in recent immigrant and refugee groups. The affective elements of spousal interaction deserve greater exploration because of their implicit and explicit ramifications for general adaptation in a new society and its potential effect on refugee health status. As this study indicated, women who had greater affectivity displayed in their conjugal relations also experienced a heightened sense of well-being, which enabled them to cope more effectively in their daily lives. Conversely, when women perceived a decrease in spousal affectivity, they often felt lonely and isolated. This, in turn, decreased women's capacity for dealing with daily events. A second factor considered in this study was the effect of wife employment on
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conjugal relations. Specifically, family decision making and the participation of husbands in household tasks were used as measures of change in spousal power differentials. The findings of this study closely followed the work of Rodman (1967) and Safilious-Rothschild (1979), who argued that the cultural context in which resources operate is important in determining their effects. This study indicated that the wife's belief system and her employment were important factors stimulating egalitarian spousal behavior. Although wife employment may have functioned as a catalyst accelerating the implementation of the egalitarian ethic, employment in itself did not guarantee more egalitarian interchange. The greatest change in spousal power differentials was apt to occur when the wife was employed and had exposure to egalitarian norms. Exposure to more liberal attitudes toward gender relations was in turn associated with competency in English and longer residency in the U.S. This study also explored the women's attitudes toward their employment. Although most women did not find intrinsic job satisfaction under their present working conditions, they did describe other rewards associated with their employment. These included self-esteem, the opportunity to interact with the outside world, and a sense of satisfaction in being able to contribute to their families' economic survival. The reasons for the disparities in women's feelings concerning their employment, under conditions of low job satisfaction, need further empirical investigation. The study additionally tended to support the use of a dynamic conceptual model that deals with the reciprocal nature of family discussions and negotiations that take place, rather than using a static model which focuses on the outcomes of family process. We focused on communication processes and attempted to delineate the strategies wives used in negotiating and resolving conflict with their husbands. This approach was less concerned with who won (i.e., outcome), than with the process by which the husband and wife resolved their differences. Although type of family system did not seem to have an appreciable effect on spousal power differentials following resettlement, it was an important factor in evaluating spousal interaction and communication processes. The data supported Liu's (1977) argument by further indicating the importance of distinguishing between open and closed family systems in cross-cultural analysis. Changes in the functional and structural dimensions of spousal relations hold implications for those persons' general health status as they begin to adapt to an alien environment. For example, women who experience a decrease in spousal affectivity also acknowledged stress in other areas of their lives. For this group of women, the loss of support systems with its concomitant feeling of loneliness, lead to a decreased ability to cope in a strange and often confusing social and cultural milieu. All forms of losses which result in stress, lead to a decreased ability of the bodys' immune system to resist illness. CHNs will therefore want to consider disruption in refugee conjugal relations as a possible source of stress. For example, questions that are useful in assessing this area include: Do you and your husband spend more or
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less time together? Do you argue more or less frequently? How does your husband feel about you working outside of the home? How do you feel about working outside of the home? Although this study addresses change in Vietnamese refugee spousal relations, we would suggest that the basic concepts of assessing functional and structural changes in conjugal relations could be extrapolated to other refugee and immigrant groups.
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CONCLUSION
"Becoming" a refugee, with its psychosocial, political, and economic ramifications, is a catastrophic life change. It is an upheaval of all that is known and familiar. It is a series of losses, which include country, home, family members, and friends. Previous support systems may be lost and earlier coping patterns may no longer be useful. Extensive research has demonstrated that the incidence of illness increases as more life change is experienced (T. S. Holmes & T. H. Holmes, 1975; Wyler, Masuda, & T. H. Holmes, 1971). In addition, when psychosocial emotional status deteriorates, there may be an increase in the severity of illness and a prolonged period of recovery (Rahe, 1978). In general, there has been very limited work done in which the health status of refugees has been viewed in relation to social risk factors. A change in spousal relations, whether viewed as positive or negative, will have an impact on the well-being of every family member. This study revealed that community health nursing assessment of the family will be strengthened by considering the health implications of stress, as related to structural and functional changes in conjugal relations. Furthermore, nursing assessments will help to develop an empirical base for interventions which will potentially maximize refugee family adaptation in the U.S. REFERENCES Caplan, N., Whitmore, J., & Choy, M. (1989). The boat people and achievement in America: A study of family values, hard work, and cultural values. Ann Arbor: The University of Michigan Press. Haines, D., Rutherford, D., & Thomas, P. (1981). Family and community among Vietnamese refugees. International Migration Review, 15, 310-3 19. Hammer, E. (1966). Vietnam yesterday and today. New York: Holt, Rinehart & Winston. Holmes, T. S., & Holmes, T. H. (1975, May). Risk of illness. Continuing Education, 48-51. Lin-Fu, J . (1988). Population characteristics and health care needs of Southeast Asian Americans. Public Health Reports, 103(1), 18-27. Liu, W. T. (1977). The myth of nuclearization of the family in the Philippines. In L. Lenero (Ed.), Beyond the Nuclear Family Model (pp. 36-61). Beverly Hills, CA: Sage. Liu, W. T., & Cheung, E (1985). Research concerns associated with the study of Southeast Asian refugees. In T. Owan (Ed.), Southeast Asian mental health (pp. 487-509). Washington, DC: National Institute of Mental Health. Liu, W. T., Lamanna, M., & Maurata, A. (1979). nansition to nowhere: Vietnamese refugees in America. Nashville, TN: Charter House. Masuda, M., Lin, K. M., & Tazuma, L. (1981). Adaptation problems of Vietnamese refugees. Archives of General Psychiatry, 37, 447-450.
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Meyers, U. (1977). Survey methods for minority communities. Journal of Social Issues, 33, 11-19. Montero, D. (1977). Research among racial and cultural minorities: An overview. Journal of Social Is-
sues, 33(4), 1-10. Montero, D. (1979). VietnameseAmericans: Patterns of resettlement and socioeconomic adaptation in the United States. Boulder, CO: Westview. Public Law 94-23, Indochina Migration and Refugee Assistance Act, May 1975. Rahe, R. H. (1978). Life change measurement as a predictor of illness. Social Medicine, 61, 1124. Rodman, H. (1967). Marital power in France, Greece and the United States. Journal of Marriage and the Family, 29, 320-324. Safilious-Rothschild, C. (1970). The study of family power structure: A review 1960-1969. Journal of
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Marriage and the Family, 32, 539-552. Warwick, D. P., & Lininger, C. A. (1975). The Sample Survey: Theory and practice. New York: McGraw-Hill. Wyler, A. R., Masuda, M., & Holmes, T. H. (1971). Magnitude of life events and serious illness. Psy-
chosomatic Medicine, 33, 115. Yu, E. (1982). Problems in Pacific/Asian American community research. In W. T. Liu (Ed.), Methodological problems in minority research (pp. 93-114). Chicago: Pacific Asian American Mental Health Research Center. Vietnamese Association of Illinois. (1989). Annual report. Chicago: Author. Zaharlick, A., & Brainard, J. (1987). Demographic characteristics, ethnicity and the resettlement of southeast Asian refugees in the United States. Urban Anthropology, 16(3-4), 327-372.
